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Medical Response to Terrorism: Preparedness and Clinical Practice

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Even two decades ago, few would have imagined that terrorism would be planned and carried out on such an enormous scale as it is today. Terrorist attacks rely on horror and surprise, invoking different times, places, victims, and methods. Their purpose is to cause widespread confusion, fear, injury, and death. They disrupt security, and even more importantly the perception of security, which is essential to the success of civilization. A framework of certainty and trust allows individuals to carry out the activities of normal life; loss of that belief can lead to distrust, fear, and even civil disruption.

Success against terrorism ultimately will result from exercising the fundamental strengths of society. Political and religious leaders must provide true leadership to their communities by openly condemning these activities. Children will be taught that no cause justifies inflicting pain and death upon the innocent. Of course there is the need to capture the perpetrators and plan to respond to the consequences of their attacks. This fight belongs to all civilized societies. However, today we do not have the necessary complete cooperation for such efforts across all geopolitical regions.

Terrorism pushes the limits of engagement to the extreme, justifying the killing of young children, for example. This loss of ethical boundaries also threatens the health care system. Precisely because it is unacceptable behavior to attack hospitals, ambulances, and health care personnel, they are at especially high risk. In addition, whether or not they are the targets, health care workers are the key agents of response to terrorism. It is critical that clinicians be able to diagnose, triage, decontaminate, and treat victims of terror attacks of all types.

The entire medical system must work together for successful consequence management. Statistics show that in mass chemical attacks, (such as occurred in the mid-1990s in Japan), a majority of victims present directly to hospitals, without triage or decontamination. It is no longer possible to assume that our colleagues who are hazardous materials (HAZMAT) experts, paramedical professionals, or military teams will conduct all triage, decontamination, and initial treatment prior to arrival at the hospital. Biological terrorism is similar in that victims are likely to present directly to hospitals and clinics. Therefore, both EMS professionals and hospital personnel must be prepared to conduct all aspects of care for the victims of terrorism.

We have learned that terrorists plan extensively to find vulnerable targets, and will likely avoid sites where there is a strong preparation. Hence, a prepared community is less likely to ever need to implement the principles contained in this text. By training in terrorism response, you are directly protecting your community and yourself from the pain, suffering, and death caused by those who no longer value the sanctity of human life.

One experienced author on hospital preparedness in this book teaches that responding to terrorism is тАЬlike a military ambush.тАЭ This means that the most important decisions must be made and practiced prior to the event. One half of this text is devoted to providing practical tools for the administrator, disaster planner and key health provider-leaders to prepare and plan for terrorism response at their clinical site.

Terrorism is an unfortunate reality of our time. This text is written by leading authorities on this topic from around the world, and we trust that the reader will find it to provide the most relevant and updated information to respond to this threat.
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